If there is one thing this election cycle has demonstrated it’s that, when ideology or emotions are involved, people can be entirely immune to facts. The narrative takes control, reinforced by motivated reasoning and confirmation bias.

Even worse, people tend to think they are actually informed, and are confident in their opinions, even when they are grossly misinformed. Regular contributors here frequently receive e-mails from people who truly believe they have it all figured out – modern medicine is a con and we are all shills, while alternative gurus speak the Truth. The confident reality distortion is amazing to behold.

A total lack of ethics and regulation

Let’s take one stunning example from the world of alternative medicine – ultraviolet blood treatment. Britt Hermes, who has contributed to SBM before, is an ex-naturopath who wrote recently about a medical device called the UVLrx. This is a device that is inserted into a vein like a catheter, and then emits UV light directly to the blood.

Because I have a university e-mail address I frequently get spam from journals I have never heard of soliciting submissions, and even offering editorial positions. I have generally ignored them, and it’s probably a good thing.

Over the last decade we have seen the rise of open-access science journals. The idea is a good one – journals charge a moderate fee to publish an article to cover costs, and then make all articles freely available online. It is a great way to leverage the power of the internet and make published science freely available. This contrasts to the subscription model where published research often sits behind a very expensive paywall.

The problem with the open-access model is that it created the means to easily generate income through predatory behavior. All you need is a website and minimal infrastructure and you can look like a real journal. Since authors are paying you to publish each article, just publish anything that gets submitted.

A recent New York Times article about how the sugar industry manipulated research starting in 1965 is getting some attention. The article is largely based on a recent JAMA Internal Medicine article that reviews historical documents revealing how the Sugar Research Foundation (SRF) (based largely on revealed internal documents) put their thumb on the scale of diet research starting in 1965 in an attempt to shift the blame for heart disease from sugar onto fat.

The diet wars

I think this latest round of information can only be understood in the context of the longstanding diet wars. Heart disease has become the number one cause of death, as life expectancy has increased and we have reduced many other causes of mortality.

Overweight and obesity are also diseases of modern civilization which is characterized by abundance and an increasingly sedentary lifestyle. Further, the food industry is driven by market forces which favor tasty foods, which often means being high in fat and/or sugar.

Using stem cells to treat disease or improve recovery is an exciting area of research. The potential is undeniably great – these are cells that have the potential to differentiate into mature cells of a specific type. They can be used to replace damaged cells or improve the environment for cell function and recovery. Ideally stem cells can be developed from cells harvested from the patient themselves, so there is no issue of rejection.

Quackery in the gap

Into this gap between the hype and potential of stem cells and the current reality of the research there is a space where dubious stem cell clinics can thrive. I first wrote about dubious stem cell clinics debuting in China nine years ago. Despite various regulatory efforts these clinics continue to thrive.

A few years ago some colleagues and I at the Institute for Science in Medicine were debating what our official position should be regarding non-medical vaccine exemptions. We all agreed that the ideal situation would be no non-medical exemptions. There is no legitimate reason for such exemptions and the evidence clearly shows that states who allow non-medical vaccine exemptions have lower vaccination rates.

The debate was about whether or not that should be our only position, to take a strong and uncompromising stance, or should we also advocate that states who do allow non-medical exemptions to make them as difficult as possible (which also is effective in reducing vaccine refusal). The concern was that the perfect solution was politically too difficult and the lesser solution was at least something (like a prosecutor including lesser charges in case they lose on the big charge).

I advocated for the latter position, which is what we ultimately decided. After the Disneyworld measles outbreak, however, I think the political calculus has changed. It is much more politically viable to simply advocate for the elimination of all non-medical exemptions. (more…)

The biggest challenge we face promoting high standards of science in medicine is not making our case to the community. Our case is rock solid, in my opinion, and backed by evidence and logic. There is no question, for example, that homeopathy is 100% bogus and should not be part of modern medicine.

Our challenge is that there are literally billions of dollars to be made selling fake medicine and dubious treatments. This means that unscientific practitioners have an immediate financial incentive to promote themselves and their treatments, and they will tirelessly do so, on any front they can find. Further, the stars of unscientific medicine have the resources to do so – to intimidate critics, cozy up to politicians, open centers in respected hospitals, and market their brand.

We simply don’t have the manpower to confront them on every front, and the mainstream scientific and medical communities are frankly just not paying enough attention. They are largely unaware that pseudoscience is infiltrating their profession right under their noses, or they have been lulled into thinking this is a small and benign phenomenon.

Patient groups

These many fronts in which science confronts pseudoscience include the media, hospitals, continuing education, journals, the marketplace, politics and regulation, and research funding.

The definition of “propaganda,” like so many things, is a bit fuzzy. The dictionary definition is: “information, especially of a biased or misleading nature, used to promote or publicize a particular political cause or point of view.” There is no sharp demarcation line, however.

Speech occurs on a spectrum from obsessively objective, fair, balanced, and scholarly at one end, to deliberately deceptive and manipulative propaganda at the other. Most speech is somewhere in the middle. We are all coming from a certain narrative, one which we believe is valid and important, and often speech is meant to be persuasive.

Persuasive speech promoting a point of view or certain conclusion is fine – it does not necessarily deserve the label of propaganda. The fuzzy line gets crossed, however, the more logic and evidence are compromised for the sake of the narrative. (more…)

Four years ago, while watching the 2012 Olympic Games, I noticed a lot of athletes wearing colored strips in various patterns on their body. I discovered that these strips were called kinesiotape, and they were used to enhance performance, reduce injury, and help muscles recover more quickly. I also discovered that these claims for kinesiotape were complete nonsense.

This year at the 2016 Rio Olympics, I (and many other people, judging by my e-mails) noticed that many athletes, especially the swimmers, had what appeared to be circular bruises on their backs, shoulders, and sometimes elsewhere on their body. I immediately recognized the telltale signs of cupping, a pseudoscientific treatment that is part of traditional Chinese medicine (TCM).

Pseudoscience in sports

What both kinesiotape and cupping have in common, other than a lack of evidence that they work, is that they are immediately visible to the casual observer (another example would be the hologram bracelets that were once common). This led me to suspect that they represent only the tip of the nonsense iceberg at the Olympics. What other worthless treatments are athletes using that don’t leave visible marks on their skin?

The pattern has repeated so many times that it is truly predictable. Scientists turn their eyes to one type of treatment that has theoretical potential. However, proper research from theory to proven treatment can take 10-20 years, if all goes well. Most such treatments will not work out – they will fail somewhere along the way from the petri dish to the clinic.

However, the media likes a good story, and one of their favorite narratives is the “new miracle cure.” They will often take preliminary basic science research and present it with headlines promising a cure for some horrible disease (sometimes they will add a question mark).

When we see these headlines, we know what will happen next – hucksters will ride the hype with a wave of snake oil products promising the same cure, and claiming to be based in science. Dr. Oz will probably promote it on his show, and Mike Adams will rant about the government conspiracy to keep this cure from the public (but he will sell it to you).

We have seen this pattern with antioxidants, stem cells, resveratrol, and countless others. Sometimes the hucksters manufacture their own hype, as with green coffee beans. They don’t wait for actual scientists, they corner the market on some worthless bean or berry, then invent health claims for it and try to hype demand through the usual channels. This sadly works. (more…)

There are many complex factors driving up the cost of healthcare, but one major factor is increasing medical technology. Often new expensive technologies provide incremental, or even questionable, additional benefits but can dramatically increase the cost of health care. This is especially true of in-hospital treatments.

There are also, of course, medical technologies that provide significant benefits, and others that improve our ability to make diagnoses. The public clearly wants and expects the latest and greatest medical technology when it comes to their health care or that of their loved-ones.

From this perspective the culture is definitely very pro-medical technology. Nothing is too invasive or heroic if it might save a loved-one. In fact, access to the latest medical miracles is considered a right, and even the suggestion that such technology might be futile is often met with hostility and anger.